
02/20/2025
U.S. Private Health Insurance examined Part 2: The Good, the Bad, and the Ugly
My practice was in-network for multiple private health insurance companies for many years. Gradually, I grew weary of the games insurance companies play with doctors and patients in order to increase their profits, so I became “out-of-network” for more and more insurance companies. My decision many years ago to drop my last insurance plan and become completely out-of-network freed me to focus my time and energy on providing the best care for my patients rather than jumping through hoops for insurance companies. However, me becoming out-of-network left in-network doctors and some patients in a worse position.
Let me explain how:
Let’s say there are 10 in-network doctors caring for 1,000 patients. This means 1 doctor cares for 100 patients. Let’s say one of those doctors decides to go "out-of-network". This has numerous downstream effects - The Good, the Bad, and the Ugly:
The Good: 1 doctor is now out-of-network, and they charge patients directly what they believe to be a fair fee for their services. 50 patients have the financial means to pay for out-of-network care. The 1 out-of-network doctor is now taking care of 50 patients instead of 100 patients, and can afford to spend more time with each patient and still pay the bills because they are being more fairly reimbursed for their services. This results in both happier patients and a happier doctor.
The Bad: The other 950 patients continue to see in-network providers because they're already paying so much for health insurance, and paying extra to see an out-of-network doctor is either not financially feasible or seems to be an unnecessary expense. The 9 doctors who are still in-network now have to take care of 950 patients. Instead of taking care of 100 patients each, these in-network doctors now need to take care of 106 patients each. The amount of work has increased, but there are still only so many hours in a clinic day. Each in-network doctor now has to squeeze in 6 extra patients into their workday. This results in shorter appointments that force the doctors to rush to accomplish the same amount of work in shorter periods of time. Patients feel rushed and unheard by their doctors. In-network doctors are forced to practice medicine in ways that make them unhappy.
The Ugly: Because of the worsening work conditions, another in-network doctor decides to become out-of-network. Another 50 patients follow them and seek out-of-network care. The remaining 8 in-network doctors now are responsible for 900 patients. Each in-network doctor is now are taking care of 113 patients instead of 106. Even shorter appointments and even longer workdays result. In-network doctors and their patients become increasingly unhappy.
Conclusion:
The U.S. private health insurance system is broken and has continued to degrade year after year. By jumping ship and becoming out-of-network, I have only worsened the problem for in-network doctors and the patients they care for. I do not know how to fix the system, but I hope that sharing my observations will help clarify the problems so that we can move towards better solutions.
*Disclaimer: I am not a health insurance or economics expert. My analysis is based on my personal observations as both a patient and doctor receiving and providing healthcare in the U.S.